PSYCHOLOGY  AND  THE  MEDICAL  SCHOOL  * 


By  E.  STANLEY  ABBOT,  M.  D., 

Pathologist  and  Assistant  Physician,  McLean  Hospital,  Waverley,  Mass. 

That  psychology  should  bear  the  same  relation  to  psycho¬ 
pathology  and  psychiatry  that  physiology  does  to  general  medi¬ 
cine  is  a  truism  that  is  almost  a  platitude.  It  is  perhaps  less 
obvious,  though  to  my  mind  not  less  true,  that  psychology  should 
rank  among  the  fundamental  sciences,  on  a  par  with  anatomy  and 
physiology,  if  not  with  chemistry,  physics  and  biology,  necessary 
for  all  students  of  medicine,  not  merely  for  those  who  intend  to 
take  up  certain  specialties.  Until  recent  times,  however,  little 
effort  has  been  made  to  introduce  this  study  into  the  medical 
curriculum.  It  will  be  introduced  if  the  demand  is  strong  enough, 
and  it  is  the  object  of  this  paper  to  interest  thl^  society  and  urge 
it  to  take  some  action  in  the  matter. 

The  need  of  psychological  instruction  is  not  an  altogether  new 
subject.  In  December,  1911,  it  was  considered  at  a  symposium  at 
the  combined  meetings  of  the  American  Psychological  Association 
and  the  Southern  Society  of  Philosophy  and  Psychology,  in  which 
Drs.  Meyer,  Franz,  Prince  and  others  took  part.  Since  then  the 
subject  has  been  brought  up  at  meetings  of  other  societies.  But 
I  believe  it  has  not  been  discussed,  at  least  in  recent  years,  by  this 
association,  which,  on  account  of  its  name,  its  membership  and 
its  size,  should  be  able  to  exert  a  strong  influence. 

Certain  specialists  need  psychology.  For  example,  it  is  obvious 
that  physiological  psychology  lies  at  the  basis  of  neurology.  And 
it  is  probably  that  field  that  Lancaster  ^  had  in  mind  when,  in  out¬ 
lining  recently  an  improved  course  in  ophthalmology,  he  included 
15  hours  out  of  a  300-hour  course  to  be  devoted  to  “psycholog¬ 
ical  problems.”  In  otology,  rhinology  and  laryngology,  too,  there 
are  a  few  problems  that  belong  in  this  field.  Psychiatry’s  need 
of  psychology  has  already  been  noted. 

Besides  this,  there  is  a  rapidly  growing  demand  for  more 
thorough  investigation  of  the  mental  states  and  processes,  not 
only  in  such  groups  as  the  neurasthenic  and  the  very  sick,  who 

*  Read  at  the  sixty-ninth  annual  meeting  of  the  American  Medico- 
Psychological  Association,  Niagara  Falls,  Canada,  June  10-13,  1913. 


87 


44^  PSYCHOLOGY  AND  THE  MEDICAL  SCHOOL  [Oct. 

come  under  the  observation  of  the  general  practitioner,  and  in 
such  groups  as  the  obviously  feeble-minded,  the  epileptic,  and  the 
hysterical,  who  usually  come  under  the  observation  of  the  neurolo¬ 
gist  or  the  psychiatrist,  but  also  in  such  groups  as  the  deaf  mute, 
the  slightly  backward  school  child,  the  defective  delinquent,  the 
criminal,  the  pauper  and  the  prostitute. 

Most  of  these  latter  groups  are  defectives.  For  the  best  ways  of 
dealing  with  them  the  community  naturally  turns  to  the  physician, 
though,  if  there  were  a  large  body  of  trained  psychologists,  it 
might  turn  to  them.  The  school  and  the  police  physicians,  who 
usually  see  these  cases  in  the  first  instance,  are  general  practition¬ 
ers,  and  it  would  be  helpful  if  they  had  the  requisite  grounding 
in  psychology  to  deal  with  them.  Franz ^  and  White®  have 
pointed  out  the  need  of  such  grounding. 

But  it  may  be  urged  that  the  generM  practitioner  sees  after  all 
only  a  comparatively  small  number  of  such  cases ;  that  they  can 
be  referred  to  specialists  who  are  sufficiently  grounded  in  psy¬ 
chology,  and  that  the  teaching  of  psychology  might  well  be  limited 
to  those  who  wish  to  fit  themselves  for  these  specialties. 

To  that  it  can  be  answered  that  since  in  almost  every  medical 
school  psychiatry  is  a  required  course,  its  foundation  science,  psy¬ 
chology,  should  be  taught  as  a  prerequisite.  But^  even  apart  from 
that,  not  only  the  specialist  but  every  practitioner  of  medicine  and 
surgery  needs  psychology. 

Lyon,®  reporting  last  February  for  the  Committee  on  Peda¬ 
gogy  at  a  meeting  of  the  Association  of  American  Medical  Col¬ 
leges,  states  one  of  the  aims  of  general  medicine  to  be  to  give 
the  student  as  much  knowledge  as  possible  of  human  beings  into  • 
whose  life  he  must  enter  in  a  much  broader,  more  sympathetic 
relation  than  that  of  engineer  to  machine.”  Franz  ^  calls  at¬ 
tention  to  the  fact  that  the  general  physician  depends  on  the 
patient  for  information  about  his  illness,  and  that  the  patient’s 
sensations  and  feelings  have  weight  in  the  diagnosis.  White  * 
refers  to  the  fact  that  there  is  a  mental  side  to  every  illness,  even 
to  a  sore  finger,  and  that  the  patient  is  a  thinking,  feeling  being. 
They  might  have  added  that  wherever  the  patient’s  co-operation 
in  the  examination  and  in  following  out  directions  for  treatment 
is  concerned,  there  are  psychological  factors  of  the  utmost  im¬ 
portance — factors  which  are  present  to  a  greater  or  less  degree 


88 


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E.  STANLEY  ABBOT 


449 


in  all  cases  except  those  in  infancy  and  childhood  and  of  un¬ 
consciousness  and  stupor.  Moreover  the  bodily  and  mental  effects 
of  such  emotional  states  as  dread  (of  operation,  death,  going  to  a 
hospital,  certain  illnesses,  etc.),  courage,  hope,  despair  are  neither 
negligible  nor  infrequent;  neither  are  the  effects  of  prejudices, 
errors,  superstitions,  or  ignorance  on  the  general  attitude  of  the 
patient  toward  his  illness,  his  treatment  and  his  physician.  These 
are  psychic  factors  that  every  physician  and  surgeon  is  likely  to 
meet  and  meet  frequently. 

Furthermore,  it  is  the  psychic  factor  in  all  illness  and  in  all 
^therapy  that  has  given  such  vogue  to  many  of  the  recent  psycho¬ 
therapeutic  movements,  whether  scientific,  pseudo-scientific,  or 
fraudulent.  It  is  the  psychic  factor  that  makes  the  success  of  the 
quack,  the  charlatan  and  the  nostrum  vendor.  A  knowledge  of 
psychology  would  help  each  physician  and  surgeon  in  the  use  of 
that  which  is  true  and  in  the  fight  against  that  which  is  false  in 
all  these  doctrines  and  practices.  The  recognition  of  the  impor¬ 
tance  of  these  psychic  factors  is  growing,  and  some  grounding 
in  them  must  be  given,  if  the  forementioned  aim  of  medical  teach¬ 
ing  is  to  be  fulfilled. 

11. 

To  find  out  how  extensively  psychology  is  being  taught  in  the 
medical  schools  of  this  country,  inquiries  were  made  of  all  the 
medical  schools  classified  by  the  Council  on  Medical  Education  of 
the  American  Medical  Association  as  A  -f  (acceptable),  A  (col¬ 
leges  lacking  in  certain  respects,  but  otherwise  acceptable),  and 
B  (colleges  needing  general  improvements  to  be  made  acceptable) . 
No  inquiries  were  made  of  the  class  C  schools  (colleges  requiring 
a  complete  reorganization  to  make  them  acceptable).  To  the 
deans  of  the  85  schools  of  these  three  classes  the  following  ques¬ 
tions  were  sent,  together  with  a  request  for  the  catalogue,  an¬ 
nouncement  or  bulletin  of  the  school : 

1.  Is  psychology  required  for  admission  to  your  school? 

2.  Is  psychology  taught  in  your  school? 

3.  If  so,  is  it  a  required  or  elective  study? 

4.  If  elective,  roughly  what  proportion  of  students  elect  it? 

5.  In  what  year  or  years  is  it  taught? 


450 


PSYCHOLOGY  AND  THE  MEDICAL  SCHOOL 


[Oct. 


6.  How  many  hours  are  given  to  it? 

7.  Is  the  instruction  by  (a)  lecture,  (b)  text-book,  (c)  labora¬ 
tory,  or  by  what  combination  of  them  ? 

8.  What  text-books  are  used? 

9.  Has  the  instructor  in  psychology  a  knowledge  of  psychiatry 
gained  from  clinical  experience? 

From  these  questions  it  will  be  seen  that  no  effort  was  made 
to  determine  the  type  of  psychology  that  is  taught,  except  as  this 
might  be  shown  by  the  text-books. 

Replies  were  received  from  58,  and  bulletins  from  only  24  of 
these.  Most  of  the  schools  are  associated  with  or  are  integral 
parts  of  some  university,  many  of  them  state  universities ;  most 
require  at  least  the  equivalent  of  two  academic  years  for  ad¬ 
mission  to  the  medical  school.  A  few  give  only  the  first  two 
years  of  the  medical  course,  omitting  clinical  teaching. 

The  following  data  are  based  on  the  58  replies  received.  The 
extent  of  psychological  teaching  is  shown  in  the  table : 


PSYCHOLOGY  IN  THE  MEDICAL  CURRICULUM. 


Class  A-1-. 

Class  A. 

ClassB. 

Total. 

Full 

course. 

First 

2  years 
only. 

Full 

course. 

First 

2  years 
only. 

Full 

course. 

Pre- Medical  Years. 
Required  for  admission . 

I 

2 

•  • 

•  • 

3 

Advised  for  admission . 

3 

2 

2 

•  • 

I 

8 

Pre-medical  course  offered  .... 

5 

2 

4 

3 

I 

15 

Medical  Years. 

Normal  psychology  required  . . . 

I 

I 

2 

4 

Normal  psychology  elective. .. . 

I 

I 

I 

*  * 

3 

Abnormal  or  path,  psych,  re¬ 
quired  . 

I 

I 

2 

Abnormal  or  path,  psych,  elec¬ 
tive  . 

I 

I 

« 

2 

Planning  to  offer  courses . 

3 

2 

I 

I 

7 

Teaching  in  connection  with 
other  courses  . 

8 

3 

II 

Total  requiring,  advising  or 
teaching . 

9 

2 

7 

5 

3 

26 

Ignoring  psychology . 

6 

15 

9 

30 

Number  replying  to  inquiries  . . 

17 

2 

22 

5 

12 

58 

Number  of  schools . 

24 

39 

22 

85 

90 


1913] 


E.  STANLEY  ABBOT 


451 


Pre-Medical  Teaching. 

In  only  three  schools  is  psychology  required  for  admission. 

In  eight  schools  it  is  scheduled  or  advised,  but  not  required. 

In  15  schools,  including  all  but  one  of  these  eight,  pre-medical 
courses  in  psychology  are  offered — required  in  three,  elective  in  12. 

The  number  of  students  electing  psychology  varies  from  a  few 
to  nearly  all,  but  averages  about  half. 

In  these  pre-medical  courses  the  time  occupied  varies  from  a 
total  of  five  hours  to  a  full  year’s  course  of  at  least  three  hours 
a  week.  Most  of  those  that  give  such  courses  teach  it  for  one  or 
two  terms. 

It  is  taught  chiefly  in  the  second,  but  sometimes  in  the  first,  of 
the  two  pre-medical  years. 

In  only  three  schools  has  the  teacher  of  psychology  had  any 
psychiatrical  experience,  and  in  two  of  those  it  is  “  limited  ”  or 
‘‘  slight.” 

Only  five  mention  the  text-books  used.  They  are  Angell,  Sea¬ 
shore,  James,  Pillsbury,  Titchener,  Storring,  Janet,  etc. 

The  method  was  not  stated  in  all  cases,  but  appears  to  be  chiefly 
by  lecture,  with  considerable  laboratory  work. 

Teaching  in  Course. 

In  the  medical  course  proper,  only  six  schools  require  psychol¬ 
ogy  as  a  separate  study,  and  five  others  offer  electives,  making 
II  which  teach  it.  Two  more  expect  shortly  to  offer  electives, 
and  will  probably  do  so  next  fall,  while  five  others  are  trying  to 
arrange  for  it,  and  may  accomplish  it  within  a  year  or  two. 

Eleven  replies  tell  of  teaching  psychology  only  in  connection 
with  physiology  or  with  psychiatry  or  neurology.  In  most  this 
does  not  mean  much,  but  in  three  it  means  that  a  definite  number 
of  lectures  in  the  course  on  physiology  or  in  that  on  psychiatry 
is  devoted  to  normal  psychology. 

Of  the  II  separate  courses  in  psychology  that  are  offered,  four 
are  described  as  “  elements  of  abnormal  psychology,”  ‘‘  the  appli¬ 
cation  of  psychology  to  neurology,”  “  pathological  psychology  ” 
and  “  psychopathology,  psychology  in  its  medical  bearing.”  The 
other  seven  appear  to  be  courses  in  physiological  or  more  general 
psychology,  in  which  such  text-books  as  James,  Titchener,  An¬ 
gell,  Pillsbury,  Yerkes,  Thorndike,  and  Witmer  are  used. 


91 


452  PSYCHOLOGY  AND  THE  MEDICAL  SCHOOL  [Oct. 

The  time  devoted  to  psychology  varies  from  5  to  108  hours, 
averaging  perhaps  45  hours. 

It  is  taught  in  the  first  year  in  two  schools,  in  the  second  in 
five,  in  the  third  in  one,  and  in  the  fourth  in  three. 

It  is  taught  chiefly  by  lecture  and  text-book ;  in  three  schools 
there  is  also  laboratory  work ;  in  one  it  is  taught  by  lecture  and 
recitation. 

In  six  of  these  1 1  schools,  the  psychological  instructor  has  had 
no  psychiatrical  experience ;  in  two  he  has  had  slight,  and  in  two 
considerable.  One  fails  to  reply  to  this  question. 

These  data  may  be  summed  up  as  follows : 

Of  the  58  schools  replying,  30  (over  50  per  cent)  quite  ignore 
psychology ;  three  require  it  for  admission ;  eight  advise  it  for  ad¬ 
mission ;  15  offer  pre-medical  courses.  During  the  medical  years 
proper,  six  require  it,  five  offer  electives,  seven  are  planning  to 
teach  it  as  a  separate  study,  while  1 1  teach  it  more  or  less  in  con¬ 
nection  with  other  courses. 

It  is  probable  that  the  amount  of  psychological  teaching  in  the 
schools  that  sent  no  replies  is  less  rather  than  more  than  that 
shown  here. 

It  is  of  interest  to  note  that  in  no  curriculum  that  I  have  seen 
has  psychology  been  mentioned  as  one  of  the  fundamental 
sciences. 

This  state  of  affairs,  though  not  good,  is  encouraging,  for 
there  is  distinctly  indicated  by  the  replies  received  a  growing 
tendency  toward  the  introduction  of  psychology  into  the  medical 
curriculum. 

III. 

The  reasons  for  the  lack  of  teaching  and  for  the  diversity 
where  it  is  taught  are  various.  They  are  grouped  about  two  main 
lines,  one  the  evolution  of  the  science,  the  other  the  evolution  of 
the  schools. 

About  the  middle  of  the  last  century  the  science  of  psychology 
grew  out  of  philosophy.  At  that  time  Spencer’s  materialistic  and 
mechanistic  conceptions  were  influencing  scientific  thought,  es¬ 
pecially  among  English-speaking  people.  There  was,  however, 
no  one  accepted  philosophy,  but  many  philosophies  with  irre¬ 
concilable  differences  in  fundamental  concepts.  The  psychologies 


92 


1913] 


E.  STANLEY  ABBOT 


453 


which  grew  out  of  these  philosophies  inherited  the  defects  of  their 
parents,  but  showed  a  rather  strong  tendency  to  be  influenced  by 
the  Spencerian  environment  into  which  they  were  born.  So,  as 
was  natural  with  young  sciences,  they  dealt  chiefly  with  the  con¬ 
crete,  tangible  phenomena  of  sense  perceptions,  sensations,  re¬ 
flexes,  time  reactions,  etc.,  and  avoided  the  more  elusive  but  more 
fundamental  and  vitally  important  factors  that  determine  human 
conduct. 

Owing  to  the  irreconcilable  differences,  due  to  their  origin, 
there  has  been  no  one  generally  accepted  psychology,  as  there  is 
one  physiology,  but  several  psychologies.  Hence  scientists  in  other 
fields  have  felt  a  certain  distrust  of  all  psychologies,  just  as  they 
have  of  all  philosophies ;  and  owing  to  the  avoidance  of  the  vital 
factors  which  determine  conduct,  psychology  has  seemed  out  of 
touch  with  life,  often  impractical,  and  not  especially  helpful  where 
the  need  for  help  has  been  felt.  Even  the  recent  growth  of  applied 
psychology,  as  seen  in  the  latest  book  by  Miinsterberg  and  in  the 
studies  in  animal  and  human  behavior,  has  not  been  able  to  over¬ 
come  psychology’s  hereditary  defects,  though  approaching  much 
nearer  to  what  is  wanted  than  earlier  efforts  did.  What  is  needed 
is  an  application  of  eugenics  to  psychology.  Out  of  biology,  not 
philosophy,  should  the  new  psychology  be  born,  sired  by  scientists 
of  broad  views,  not  unacquainted  with,  but  unafraid  of,  the 
various  philosophic  viewpoints,  and  with  courage  to  attack  the 
most  complicated  and  intangible  of  problems.  Such  a  psychology 
would  be  a  healthy  normal  science,  well-developed,  whose  funda¬ 
mental  concepts,  view-points  and  methods  would  be  as  generally 
recognized  and  accepted  as  are  those  of  physiology.  It  would  be 
found  helpfully  applicable  to  the  various  problems  of  life,  and 
could  be  taught  with  as  great  advantage  as  physiology  now  is. 

The  medical  curriculum  long  antedated  the  science  of  psychol¬ 
ogy.  There  was  therefore  no  place  for  this  science  in  the  old 
curricula.  The  enormously  rapid  growth  of  the  other  biologic  and 
seemingly  more  strictly  medical  sciences  has  been  crowding  and 
stretching  the  curriculum.  Hence,  though  the  importance  of  the 
psychic  factors  in  disease  has  been  increasingly  recognized  and  the 
need  of  psychological  investigation  of  them  has  been  increasingly 
felt,  it  has  been  difficult  to  make  a  place  for  psychology  in  the  medi' 
cal  course.  The  facts  above  noted,  that  psychology  has  not  been  a 


93 


454  PSYCHOLOGY  AND  THE  MEDICAL  SCHOOL  [Oct. 

unitary  science  and  that  it  only  remotely  touched  the  needs  of 
the  medical  student  or  physician,  have  delayed  its  inclusion  as 
a  required  course.  These  are  the  chief  general  reasons  why  psy¬ 
chology  is  not  more  generally  taught  in  the  medical  schools. 

Others  are  more  local  and  personal  to  the  individual  schools, 

W. 

At  the  above  mentioned  symposium  and  elsewhere  three  sug¬ 
gestions  for  courses  in  psychology  have  been  published ;  one  by 
a  psychologist,  one  by  a  neurologist,  and  one  by  a  psychiatrist. 

Each  proponent  illustrates  the  faults  of  his  type,  though  it  is  only 
fair  to  say  that  each  probably  had  the  conditions  in  his  own  school 
in  mind,  and  that  this  would  greatly  modify  the  plan  proposed. 

It  would  take  too  long  to  even  sketch  them  here,  so  I  will  merely 
offer  a  few  comments. 

Professor  Watson,^  the  psychologist,  outlines  a  course  with  far 
too  much  physiological  and  far  too  little  psychical  psychology, 
and  it  is  too  little  applied  to  the  needs  of  the  medical  student. 

It  makes  one  think  of  trying  to  teach  architecture  by  devoting  a 
great  deal  of  time  to  building  materials  and  comparatively  little 
to  design. 

Dr.  Prince,®  the  neurologist,  frankly  states  that  the  course  he 
outlines  is  rather  supplementary  to  Professor  Watson’s  than  a 
substitute  for  it.  For  a  foundation  course  it  lays  altogether  too 
much  stress  on  morbid  processes,  on  hypnotism,  and  on  such  un¬ 
common  conditions  as  dissociations  and  syntheses  of  personalities. 
Furthermore  it  is  based  on  his  not  yet  generally  accepted  theory 
of  the  subconscious.  Except  as  an  advanced  course  in  psycho-  ' 
patholog}^  it  is  uneven,  with  many  parts  too  little  and  others  too 
much  accentuated. 

The  third.  Dr.  Meyer’s,®  outline,  is  by  far  the  best  of  the  three. 
Especially  good  are  the  biological  view  point,  the  recognition  of 
“  relativity  of  effects  ”  (which  I  call  multiplicity  or  complexity 
of  factors  involved),  and  his  insistence  on  observation  and  on  f 

study  of  factors  which  may  modify  reactions.  He  perhaps  lays 
somewhat  more  emphasis  on  some  of  the  Freudian  mechanisms, 
such  as  symbolic  disfigurements,  substitutions,  wish-fulfilments,  i 

etc.,  and  somewhat  less  on  effects  of  emotional  states,  education, 
formation  of  purposes,  ideals,  etc.,  than  I  should,  thus  including 


94 


1913] 


E.  STANLEY  ABBOT 


455 


a  little  more  of  morbid  psychology  than  a  preliminary  course 
should  have.  But  it  seems  a  fairly  well-rounded  course,  helpful 
to  the  general  practitioner  as  well  as  to  the  specialist. 

But  destructive  criticism  is  easy,  and  often  thankless,  while 
constructive  planning  is  difficult.  It  may  be  hardly  fair  to  criti¬ 
cize  any  of  these  suggested  courses  before  they  have  been  tried 
out,  on  merely  d  priori  grounds,  especially  as  those  are  the  only 
basis  of  the  following  suggestions. 

Since  the  medical  curriculum  is  already  so  full,  the  psychology 
that  is  added  to  it  should  be  limited  to  the  actual  needs  of  the 
student — it  should  be  a  strictly  applied  psychology,  with  its  appli¬ 
cations  shown  throughout  the  course. 

That  part  of  the  course  in  physiology  which  deals  with  the 
nervous  system  and  the  special  senses  could  be  expanded  to  in¬ 
clude  the  physiological  psychology  needed  to  understand  the 
tests  used  by  neurologists  (including  various  time-reactions,  tests 
for  aphasia,  astereognosis,  etc.),  ophthalmologists,  otologists, 
rhinologists,  and  laryngologists,  and  to  include  also  the  somatic 
effects  (motor,  vaso-motor,  secretory,  etc.)  of  affective  states 
in  general,  such  as  fear,  depression,  euphoria. 

The  course  in  psychology  proper  should  be  largely,  though  not 
entirely,  an  observational  one,  teaching  the  student  to  see  what  the 
various  psychological  factors  are  which  determine  the  conduct 
and  behavior  of  individuals  in  the  ordinary  acts  of  life.  To  this 
end  it  would  be  analytical  and  partly  introspective.  There  should 
be  as  much  experimental  work  as  is  needed  to  give  an  idea  of  the 
scope  and  application  of  the  Binet-Simon  and  other  general  in¬ 
telligence  tests,  free  and  controlled  association  tests,  memory 
tests,  attention  tests,  observation  and  reproduction  (testimony) 
tests,  etc.  This  would  give  the  student  a  certain  familiarity  with 
the  ordinary  tests  used  in  the  investigation  of  the  neuroses,  the 
neuropsychoses,  the  psychoses,  and  the  states  of  mental  defect. 

The  student  should  be  taught  the  factors  and  mechanisms  in¬ 
volved  in  the  learning-process  and  in  habit-formation ;  in  orien¬ 
tation  and  grasp  of  the  situation  in  which  the  person  finds  him¬ 
self  ;  in  instinctive  action ;  in  the  formation  of  purposes  and 
ideals ;  in  the  carrying  out  of  the  purposes  formed.  He  should 
be  taught  the  influence  of  the  affects  and  affective  states,  not  only 
on  the  body,  but  on  the  other  psychical  processes  and  contents  ;  the 


95 


456 


PSYCHOLOGY  AND  THE  MEDICAL  SCHOOL 


[Oct. 


modifying  effects  on  mental  reactions  (both  as  processes  and  as 
content),  not  only  of  such  bodily  conditions  at  toxaemias,  fatigue, 
permanent  or  temporary  destruction  of  nerve-cells  or  nerve  tracts, 
imperfect  development,  etc.,  and  of  other  psychic  states  and  atti- 
’  tildes,  such  as  recollections,  prejudices,  superstitions,  and  affects 
like  shame,  indignation,  pride,  etc.,  but  also  of  education,  exper¬ 
iences,  habit  and  environment.  And  he  should  be  taught  the 
general  directions  in  which  these  modifying  factors  produce  their 
effects. 

The  course  should  be  given  from  the  biological  standpoint — 
that  all  the  activities  of  the  individual  are  reactions  to  an  environ¬ 
ment  or  to  other  internal  activities  of  his  own ;  that  these  reac¬ 
tions  are  determined  partly  by  the  environment,  partly  by  the 
bodily  condition  of  the  individual,  partly  by  his  capacity  to  react ; 
and  that  any  given  act,  no  matter  how  simple-seeming,  is  com¬ 
plex  and  multiform,  the  resultant  of  a  great  many  factors,  many 
of  which  are  unknown  and  any  one  or  any  number  of  which  is 
capable  of  modification. 

Some  such  course  as  this  would  prepare  the  student  for  the 
later  study  of  formation  of  complexes  and  of  delusions,  auto¬ 
matisms,  blocking,  dissociations,  thinking  difficulties,  defects,  etc., 
in  the  courses  on  psychopathology  and  psychiatry.  It  should  be 
given  after  the  course  in  physiology  and  physiological  psychology, 
and  would  need  probably  two  semesters.  The  methods  used  would 
necessarily  depend  on  the  local  conditions  in  each  school  and  on 
the  instructor. 

The  person  who  should  teach  psychology  to  medical  students 
should  know  both  psychology  and  medicine ;  and  a  knowledge  of  . 
morbid  mental  states  also  is  of  especial  value  to  such  a  teacher. 
Though  several  of  the  schools  offer  academic  courses  given  by 
psychologists  without  experience  in  morbid  mental  phenomena, 
some  schools  question  the  value  to  the  medical  student  of  psy¬ 
chology  as  so  taught  and  even  the  right  of  the  faculty  to  make 
psychology  a  required  study  unless  it  be  adapted  to  the  needs  of 
the  medical  student  by  men  trained  in  psychiatry  as  well  as  in 
psychology.  Hence  a  psychiatrist  with  a  working  knowledge  of 
psychology  or  a  psychologist  with  a  knowledge  of  medicine  and 
a  familiarity  with  mental  diseases  would  be  the  ideal  teacher. 
The  psychological  interests  of  either  should  be  not  so  much 

96 


1913] 


E.  STANLEY  ABBOT 


457 


in  time  relations,  intensities  of  stimuli,  and  other  factors  testa¬ 
ble  and  measurable  by  laboratory  methods,  as  in  the  more  elusive, 
less  easily  definable  factors  that  enable  the  individual  to  ad¬ 
just  himself  to  the  constantly  changing  situations,  near  and 
remote,  in  which  he  finds  himself  throughout  his  life.  Though 
there  are  few  such  teachers  now,  if  psychology  is  taught  in  the 
medical  schools  it  will  not  be  many  years  before  there  will  be 
enough  to  teach  it  well,  to  the  great  benefit  of  the  medical  prac¬ 
titioners  and  the  communities  they  serve. 

V. 

What  can  this  association  do  ? 

In  its  membership  are  many  teachers  in  the  medical  schools. 
If  they  could  raise  and  agitate  the  question  in  their  own  faculties 
it  would  hasten  the  introduction  of  this  study  into  those  schools. 
I  urge  them  to  do  this. 

If  the  association  could  take  official  action,  in  the  form  of  a 
resolution,  strongly  recommending  the  introduction  of  psychology 
into  the  medical  curriculum,  it  would  back  up  and  add  weight 
to  the  efforts  of  the  individual  members  of  faculties. 

A  committee  could  be  formed  to  investigate  further  the  present 
status,  the  results  and  the  future  possibilities  of  psychological 
teaching.  The  reports  and  recommendations  of  such  a  com¬ 
mittee  could  be  sent  to  the  various  medical  schools,  to  the  Com¬ 
mittee  on  Medical  Education  of  the  American  Medical  Associa¬ 
tion,  and  to  the  Committee  on  Pedagogy  of  the  Association  of 
American  Medical  Colleges. 

Through  such  efforts,  and  others  that  may  occur  to  other 
members  of  the  association,  this  desirable  end  may  in  time  be 
accomplished. 


REFERENCES. 

1.  S.  I.  Franz:  Jour.  A.  M.  A.,  Vol.  58,  p.  909. 

2.  W.  B.  Lancaster:  Bost.  Med  &  Surg.  Jour.,  Vol.  168,  p.  576. 

3.  E.  P.  Lyon:  Jour.  A.  M.  A.,  Vol.  60,  p.  1049. 

4.  A.  Meyer:  Jour.  A.  M.  A.,  Vol.  58,  p.  911. 

5.  A.  Meyer:  Jour.  Abn.  Psychol.,  Vol.  7,  p.  313. 

6.  M.  Prince:  Jour.  A.  M.  A.,  Vol.  58,  p.  918. 

7.  J.  B.  Watson:  Jour.  A.  M.  A.,  Vol,  58,  p.  916. 

8.  W.  A.  White :  Jour.  A.  M.  A.,  Vol.  58,  p.  1417. 


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